Contribution of serotonin 5-HT<sub>2A</sub> receptor to antidepressant effect of serotonergic psychedelics
Folia Pharmacologica Japonica – March 28, 2023
Source: OpenAlex
Summary
A compelling finding in Medicine reveals that 30-40% of major depressive disorder patients are treatment-resistant. While Ketamine offers an antidepressant option, Psilocybin, a Serotonergic hallucinogen alkaloid, is emerging as a safer alternative. Recognized by the FDA as a "breakthrough therapy," Psilocybin shows fast, lasting effects, even for treatment-resistant cases. This "psychedelic renaissance" in Psychiatry explores how these compounds, including Lysergic acid diethylamide, influence Serotonin receptors. Psychology and Pharmacology are delving into their mechanisms, offering hope for Anxiety and depression via Neurotransmitter Receptor Influence on Behavior, advancing Psychedelics and Drug Studies.
Abstract
Major depressive disorder presents a substantial global health burden, and at least 30-40% of patients exhibit treatment resistance to antidepressants. Ketamine, an NMDA receptor antagonist, is used as an anesthetic agent. In 2019, the U.S. Food and Drug Administration (FDA) approved esketamine (the S-enantiomer of ketamine) as a therapeutic agent for treatment-resistant depression; however, this drug has reportedly been associated with serious side effects such as dissociative symptoms, thus limiting its clinical use as an antidepressant. Recently, various clinical studies have reported that psilocybin, the psychoactive substance found in magic mushrooms, has a fast-acting and long-lasting antidepressant effect in patients with major depressive disorder, including those resistant to conventional treatment. Furthermore, psilocybin is a psychoactive drug that is relatively harmless compared to ketamine and other similar substances. Accordingly, the FDA has designated psilocybin as a "breakthrough therapy approach" for the treatment of major depressive disorder. Additionally, serotonergic psychedelics such as psilocybin and lysergic acid diethylamide show some potential in the treatment of depression, anxiety, and addiction. The increased attention the use of psychedelics has attracted as a psychiatric disorder treatment approach is referred to as the "psychedelic renaissance". Pharmacologically, psychedelics cause hallucinations by stimulating cortical serotonin 5-HT2A receptors (5-HT2A), although whether 5-HT2A is responsible for the manifestation of their therapeutic effects remains unclear. Furthermore, it is unclear whether the hallucinations and "mystical experience" that the patients go through because of 5-HT2A activation by psychedelics is essential for the therapeutic effect of these substances. Future research should elucidate the molecular and neural mechanisms underlying the therapeutic effects of psychedelics. This review summarizes the therapeutic effects of psychedelics on psychiatric disorders such as major depressive disorder in clinical and pre-clinical studies, and discusses the possibility of 5-HT2A as a novel therapeutic target.